| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAKESHORE BENEFIT ALLIANCE LLC3 Filed as: LAKESHORE BENEFIT ALLIANCE, LLC | 600 LUCKIE DRIVE, SUITE 315 BIRMINGHAM, AL 35223 | GUARDIAN LIFE INSURANCE COMPANY | $4K | $3K | $7K | 7.13% |
| BXS INSURANCE INC3 Filed as: BANCORPSOUTH INS SERVICES | 8315 CANTRELL ROAD, SUITE 300 LITTLE ROCK, AR 72227 | GUARDIAN LIFE INSURANCE COMPANY | $6K | — | $6K | 5.94% |
| THE MATHIS-HILL-ROBERTSON AGENCY3 Filed as: MATHIS-HILL-ROBERTSON AGENCY | 5040 ROSWELL ROAD, SUITE 100 ATLANTA, GA 30342 | GUARDIAN LIFE INSURANCE COMPANY | $82 | — | $82 | 0.08% |
| BXS INSURANCE INC3 Filed as: BANCORPSOUTH INSURANCE SERVICES | P.O. BOX 3809 BATON ROUGE, LA 70821 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 9.82% |
| THE PRIESTLEY COMPANY3 | 3100 SUNVIEW DRIVE, SUITE 100 BIRMINGHAM, AL 35243 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $994 | — | $994 | 5.08% |
| THE PRIESTLEY COMPANY3 | 3100 SUNVIEW DRIVE, SUITE 100 BIRMINGHAM, AL 35243 | HUMANA, INC. | $654 | — | $654 | 5.42% |
| BXS INSURANCE INC3 Filed as: BANCORPSOUTH INS SER INC - GULFPORT | P.O. BOX 250 GULFPORT, MS 395020250 | HUMANA, INC. | $437 | — | $437 | 3.62% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ALABAMA | 154 | $975K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY | 82 | $101K |
| Vision | HUMANA, INC. | 73 | $12K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 128 | $20K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 128 | $20K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ALABAMA | 154 | $975K |
| Other | BLUE CROSS BLUE SHIELD OF ALABAMA | 154 | $975K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 154 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.